7 Cedar Street, Suite 202 Sudbury, ON P3E 1A

Transcription

1 7 Cedar Street, Suite 202 Sudbury, ON P3E 1A To: Northeast EMS Providers CC: J. Cruickshank, J. Bradbury From: Dr. Jason Prpic, Regional Medical Director Re: Deployment and/or Redeployment of Zoll X Series Monitors (14-03) Date: February 19, 2014 The Health Sciences North Centre for Prehospital conditionally approves the deployment and/or redeployment of Zoll X series monitors/defibrillators. This is conditional upon ensuring that all paramedics have read and understand the educational packages prior to deployment and/or redeployment of the Zoll X series monitors/defibrillators. The attached educational packages for review are as follows: Zoll X Defibrillator/Monitor 12 Lead EKG Algorithm Notes & STEMI Criteria Zoll Defibrillator Troubleshooting Guide Defibrillator Pads Please do not hesitate to contact me if you have any questions or concerns. 1

2 ` Zoll X Defibrillator/Monitor 12 Lead EKG Algorithm Notes & STEMI Criteria February 19,

3 Zoll X Defibrillator/Monitor12 Lead EKG Algorithm Notes & STEMI Criteria PREAMBLE With the introduction of the X Series, ZOLL transitioned to a new advanced 12-Lead algorithm for the detection of acute and prior myocardial infarctions (MI). This algorithm, developed by Inovise Medical, has improved sensitivity for identifying acute MI, but employs different nomenclature in its interpretive statements from those used by the ZOLL E Series. This has led to some confusion, as traditionally with the old software, any ST Elevation would be interpreted as *** ACUTE MI ***. With the new Inovise software in the Zoll X units, depending on the ST changes and the category that the algorithm decides, the interpretive statement could read one of five possibilities. Although this change is designed to provide more information on the type of ST Elevation to better help with guidance for STEMI activation protocols (to decrease false activation rates), there has been some concerns raised by the Base Hospital with the sensitivity and specificity of this within each category, and the confusion that can be caused by so many different types of possible interpretive results. Therefore, it has been decided by the Base Hospital that any one of the five possible interpretive statements for ST elevation MI be treated as an Acute STEMI (*** STEMI ***) for the purposes of STEMI activation and bypass. Please notify the Base Hospital immediately if any problems/concerns encountered or questions. STEMI CRITERIA The possible interpretive statements for ST Elevation with the Inovise (Zoll X) are as follows : <Acute STE (lesion location) Infarct> or ***STEMI*** (Category 1) <Probable Acute STE (lesion location) Infarct> (Category 2) <Acute Anterior Infarct> (Category 3) < (Lesion location) Infarct, Probably Acute (Category 4) When you see the words Possible or Possibly it is indicative of a Category 5 finding: < (Location) Infarct, Possibly Acute> - (Category 5) NOTE: ** Any of the interpretive reports noted above should all be treated as an ST Elevation MI (***STEMI***) when it comes to the activation of STEMI Alerts and bypass. 2 P age

4 Zoll X Defibrillator Troubleshooting Guide Defibrillator Pads February 19,

5 Zoll Defibrillator Troubleshooting Guide PREAMBLE A comprehensive investigation by Zoll and the Base Hospital was performed reviewing cases whereby the Zoll X series would give the error message, Check Pads, and subsequently would not appropriately analyze. After reviewing the data and bench testing by Zoll on both the defibrillator units and PADS, it has been determined the issue is not with the Zoll X unit or the PADS themselves, but rather the proper coupling of the pads to the patient. Due to changes in the impedance with the new monitor/pads, it is imperative that these pads are appropriately placed on the patient preventing any hair, debris, gap/air pockets, etc, between the pad and the patient. Although previous defibrillators would often allow for some hair, etc, between the pad and the patient, with the change in the impedance of the Zoll X series, it requires the pads to be placed in such a way to minimize any potential barriers between the pad and the patient s skin. Please refer to the following guide for proper PAD application and cable troubleshooting. It would be advisable to have back-up PADS available should the need arise to change the pads if an error occurs and a new set need to be re-applied. Please notify the Base Hospital immediately if any problems/concerns encountered or questions. TROUBLESHOOTING GUIDE Troubleshooting Guide for Check Pads The ZOLL Defibrillators will display a CHECK PADS and/or a Paddle/Pads Lead Fault messages when valid patient impedance is not detected by the device. 2 P age

6 Zoll Defibrillator Troubleshooting Guide This can be caused by a loose connection or poor coupling of the electrode to the patient s skin. The following steps should be taken if you encounter this message: Ensure PADS lead is selected. Ensure that all connections are secure. o Multi Function Cable (MFC) to X Series (red connector) o CPR connector to CPR Stat Padz connection (green connector) o MFC to CPR connector 3 P age

7 Zoll Defibrillator Troubleshooting Guide Verify all cables integrity (no cuts, tears in shielding of MFC, Pads cables) Evaluate electrode (pads) to patient contact is secure (complete adhesion with no lifted corners). Ensure patient s skin was prepared prior to electrode application (no air pockets or excessive hair between electrode and patient s skin). If patient was not prepared, remove electrodes and follow skin preparation and electrode application provided below. Skin preparation and electrode application: Remove excessive hair from area of pad application by shaving or clipping hair. Quickly dry and clean patient s skin (removal of perspiration, dead skin cells, oil, lotions, etc) by briskly rubbing the skin (with patient s clothing, towel, gauze pads, etc). Apply electrodes starting with one edge (#1 on Diagram) and rolling the electrode onto the patient s skin (#2 on Diagram) to avoid creating air pockets. 4 P age